ICD-10 code S92.406G: Nondisplaced right lesser toe fracture, delayed healing

Key Takeaways

ICD-10 code S92.406G describes a nondisplaced unspecified fracture of the right lesser toe(s), subsequent encounter for fracture with delayed healing.

The 7th character G signals a follow-up visit where the fracture has not healed within the expected timeframe but does not yet meet criteria for nonunion (K) or malunion (P).

S92.406G is fully billable, valid for HIPAA-covered transactions, and POA exempt – injury codes are not subject to the Present on Admission indicator.

Pabau’s claims management software embeds ICD-10-CM code selection directly into clinical notes and invoicing, reducing manual transfer errors at point of care.

Claims coders and orthopedic teams encounter ICD-10 code S92.406G most often at follow-up appointments when a lesser toe fracture is healing more slowly than expected. The full official descriptor is: Nondisplaced unspecified fracture of right lesser toe(s), subsequent encounter for fracture with delayed healing. This code became effective October 1, 2025 under the FY2026 ICD-10-CM diagnostic coding release and remains valid for the current fiscal year.

The code sits within the S92 fracture category (fractures of foot and toe), which falls under the broader S90-S99 injury chapter. According to the CMS ICD-10-CM coding page, all S92 codes require a 7th character to capture encounter type and healing status. S92.406G is the specific combination for right laterality, nondisplaced position, and delayed healing on a return visit.

The quick-reference attributes table below confirms the code’s key billing properties.

What does S92.406G mean? Breaking down the code

Every character in S92.406G carries a specific meaning. Misreading even one character – particularly the 7th – leads to claim rejections or downcoding at subsequent visits. Here is the character-by-character breakdown.

The parent hierarchy runs: S00-T88 (injury codes) > S90-S99 (ankle and foot injuries) > S92 (fracture of foot and toe) > S92.4 (fracture of lesser toe) > S92.40 (fracture of unspecified lesser toe) > S92.406 (nondisplaced unspecified fracture of right lesser toe) > S92.406G.

The digit “6” in the 5th position specifies both displacement status (nondisplaced) and laterality (right). This matters for medical billing workflow: Payers increasingly audit laterality specificity, and an unspecified-side code on a right-sided fracture documented in the clinical record raises edit flags.

Understanding the 7th character G: Subsequent encounter with delayed healing

The 7th character is not administrative shorthand. It signals the clinical status of the fracture at the time of the visit. Getting it wrong means the code no longer reflects what the provider saw and documented.

Character G specifically means: The patient is returning for care after the initial treatment episode, and the fracture is not healing at the expected rate. “Delayed healing” does not mean nonunion – the bone is still progressing toward union, but more slowly than typical. Once union fails entirely, the appropriate 7th character shifts to K (nonunion). The full 7th character extension table for S92.406x is below.

The clinical distinction between G and D turns on documentation. If the physician’s note records that healing is progressing normally on follow-up, D is appropriate. When notes document slower-than-expected callus formation, persistent pain disproportionate to timeline, or imaging showing incomplete bridging beyond the expected window for a lesser toe fracture, G applies. Consult a certified medical coder or the CDC/NCHS ICD-10-CM web tool to verify coding decisions against current guidelines.

Understanding subsequent encounter coding conventions across ICD-10-CM fracture categories helps avoid the common error of reusing character A at every follow-up visit. Once the patient has received definitive treatment and is in the recovery phase, the 7th character must change from A to D, G, K, P, or S depending on healing status.

Clinical definition: Nondisplaced fracture of the right lesser toe

A nondisplaced fracture means the bone has cracked or broken but the fragments have not shifted from their anatomical position. No manipulation is required to realign the bone. This contrasts with displaced fractures, where fragments separate and often require manual reduction or surgical intervention.

The “lesser toes” are the 2nd through 5th toes, excluding the hallux (great toe). Lesser toe fractures are among the most common foot injuries seen in outpatient orthopedic and podiatric settings. The most frequent causes include:

• Stubbing the toe against a hard surface
• Crush injuries from dropped objects
• Falls, particularly in older adults
• Stress fractures from repetitive loading in athletes

The term “unspecified” in the code descriptor means the clinician or coder has not identified which of the four lesser toes is affected, or the documentation does not specify the exact toe. Where the clinical record identifies a particular toe (e.g. the 4th toe), a more specific code within the S92.4 family may apply. Review the tabular list via the AAPC ICD-10-CM code lookup for toe-specific codes.

Approximate synonyms accepted for S92.406G include: Right small toe fracture nondisplaced delayed healing, nondisplaced fracture right lesser digit subsequent encounter, and right lesser toe fracture non-displaced slow healing follow-up visit.

Billable status, POA indicator, and claim submission

S92.406G is a fully billable, specific ICD-10-CM code. It is valid for submission on HIPAA-covered electronic transactions without additional specificity. For physiotherapy billing compliance and orthopedic claims alike, this code can appear as a principal or secondary diagnosis depending on whether the delayed healing is the primary reason for the visit.

Injury codes in the S chapter are POA exempt. Present on Admission (POA) indicators are required by CMS for inpatient claims, but external cause codes and injury-related diagnosis codes – including all S92 fracture codes – are excluded from this requirement. Coders do not need to append a POA indicator when submitting S92.406G on an inpatient claim.

One common submission error: Submitting S92.406G on the first encounter after injury. Character G is valid only when active treatment has already been initiated (the A encounter has already occurred). Using G at the initial visit will typically result in a claim edit or medical necessity denial. Sound denial management processes catch this pattern quickly, but prevention at point-of-care coding is far more efficient than post-submission appeals.

Related ICD-10-CM codes in the S92.406 family

S92.406G belongs to a tightly grouped family of codes that share the same base descriptor but differ by laterality and 7th character. The table below covers the most commonly referenced sibling and near-neighbor codes. Refer to ICD List for the full S92.4 category listing.

When a patient with a known right lesser toe fracture presents for follow-up and imaging now shows malunion (the bone has healed in a misaligned position), the code transitions from G to P. If the bone has failed to unite entirely, move to K. These are clinical determinations made by the treating provider and documented before the coder selects the 7th character.

ICD-10-CM coding guidelines for fracture codes

Section I.C.19 of the ICD-10-CM Official Guidelines for Coding and Reporting, maintained by CMS and NCHS, governs fracture coding. Key rules that apply directly to S92.406G:

• 7th character is mandatory: Fracture codes in the S92 category are not complete without the 7th character. A claim submitted with S92.406 (no 7th character) will reject as invalid.
• Encounter type follows the patient, not the provider: If a patient sees a new physician for an ongoing fracture already in the subsequent encounter phase, the provider still uses character D or G (not A).
• Laterality must match documentation: If the record documents the right foot but the coder selects the left-side code, this is a coding error regardless of similarity.
• Nondisplaced is the default only when documentation supports it: If the record does not specify displaced or nondisplaced, the guidelines direct coders to default to nondisplaced. This is why S92.406G (nondisplaced) may appear more frequently than its displaced counterpart in practices where imaging reports are not always explicit.
• Sequela coding (S character) requires separate rules: Once the fracture has healed and the patient presents with a late effect, the S character applies along with a code for the specific sequela condition.

Documentation requirements for S92.406G

A documentation checklist for clinical teams preparing records that will support ICD-10 code S92.406G:

• Confirm nondisplaced status: Imaging report or physician note must state that bone fragments remain in alignment. “Hairline fracture” or “stress fracture” without displacement language should still specify.
• Laterality (right): The word “right” must appear in the clinical note or radiology report. “Bilateral” would require separate codes.
• Encounter type: Document that this is a follow-up, return, or subsequent visit after the initial treatment episode.
• Delayed healing: The note should state that healing is progressing slower than expected, include a clinical rationale (imaging findings, symptom persistence), and indicate that nonunion criteria are not yet met.
• Which toe(s) affected: Specify the toe if known. If a single toe is identified, consider a more specific code. Document “unspecified” only when the affected toe cannot be determined.

Practices using ICD-10-CM coding guidelines across specialties benefit from structured note templates that prompt clinicians to capture these specifics at every encounter, not just at the initial visit.

When to use S92.406G vs other S92.406 codes

The clinical decision table below helps coders and providers select the correct 7th character at each point in a patient’s fracture treatment journey. The key variable is what the physician documents about healing status at that specific visit.

Delayed healing (G) and nonunion (K) are the most frequently confused characters. The practical distinction: A fracture with delayed healing still has biological potential to unite, while a nonunion has definitively failed to bridge. Radiographic and clinical criteria for this distinction vary by provider and institution, so the physician must make that determination explicitly in the record before the coder applies the 7th character.

Associated CPT codes and billing considerations for S92.406G

ICD-10 code S92.406G is a diagnosis code. It always pairs with a CPT procedure code that describes what the provider actually did during the visit. Most delayed-healing follow-up visits for lesser toe fractures pair with evaluation and management (E/M) codes, though procedure codes may apply when intervention occurs.

Common CPT codes used alongside S92.406G include:

CPT code selection for procedure codes (28510, 28515) depends on clinical judgment and payer-specific coverage policies. The table above is illustrative, not prescriptive. Verify current CPT descriptors with the AMA CPT code set before billing.

Payer rules around global surgery periods also affect whether a follow-up visit at the delayed-healing stage can be billed separately or falls within the original procedure’s global period.

Practices submitting ICD-10 claims electronically can reduce manual code-transfer errors by connecting diagnosis selection directly to their billing workflow. Pabau integrates with electronic claims via Claim.MD, routing validated ICD-10 and CPT pairings through to 4,000+ US payers without requiring coders to re-enter codes in a separate billing system.

The claims management software captures the diagnosis code at point-of-care documentation and carries it through to the superbill and electronic claim automatically.

For physical therapy clinic requirements and orthopedic outpatient settings, the superbill documentation workflow becomes especially important when delayed-healing fractures require multiple follow-up visits over weeks. Documenting the correct 7th character at each encounter ensures the claim history supports the ongoing medical necessity of continued care.

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Conclusion

Delayed healing after a right lesser toe fracture is a genuine clinical complication, and the coding must reflect it precisely. Using S92.406D when the physician has documented slow healing understates the clinical picture and misrepresents the visit for payer review.

Pabau’s revenue cycle management tools embed ICD-10 code selection into clinical documentation and connect it directly to electronic claims, so the 7th character chosen at the point of care flows through to the payer without a separate re-entry step. To see how this works in an orthopedic or podiatric practice workflow, book a demo.

Continue your research

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Coding delayed healing across fracture categories? Clean claim submission requirements outlines what payers look for when reviewing fracture-related subsequent encounter codes.

Want to understand how claims move through the system? How a medical claims clearinghouse works explains the pathway from ICD-10 code selection to payer adjudication.

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